Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Shields, NE34 0PL, UK.
Translational and Clinical Research Institute, Newcastle University, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, UK.
Skeletal Radiol. 2021 Oct;50(10):2069-2078. doi: 10.1007/s00256-021-03767-y. Epub 2021 Apr 15.
Radiographs are the first-line investigation for knee osteoarthritis (OA). Antero-posterior (AP) and Rosenberg views have demonstrated varying sensitivities in detecting severe OA. There is a multitude of radiological grading systems described. The aim of this study was to assess four commonly used grading systems in terms of inter- and intra-observer reliability and correlate the results with patient-reported symptom severity.
This study included 100 patients who had undergone both AP and Rosenberg X-ray views of the knee and evaluated using four radiological grading systems. These included Kellgren & Lawrence (K&L), International Knee Documentation Committee (IKDC), Ahlbäck and Fairbank. Evaluations were performed by two observers, independently, at two separate time points, 8 weeks apart. The data was then statistically analysed and inter- and intra-observer reliability calculated.
A significant difference was found between AP and Rosenberg views for all four grading systems (p < 0.001). Both inter- and intra-observer reliability were highest for IKDC (0.79 and 0.86 respectively) and lowest for Fairbank (0.20 and 0.27 respectively). No statistically significant correlation was found between any grading system and the Oxford knee score (OKS).
IKDC was found to be the most reliable grading system and Fairbank was the least. The Rosenberg view was overall more sensitive at detecting severe OA than the AP view. Radiological findings did not correlate with patient-reported symptoms (OKS).
X 射线是膝关节骨关节炎（OA）的一线检查方法。前后位（AP）和 Rosenberg 位 X 线片在检测严重 OA 方面具有不同的敏感性。已经描述了许多放射学分级系统。本研究旨在评估四种常用的分级系统在观察者间和观察者内的可靠性，并将结果与患者报告的症状严重程度相关联。
本研究纳入了 100 例患者，这些患者均接受了膝关节 AP 和 Rosenberg X 射线检查，并使用了四种放射学分级系统进行评估。这些分级系统包括 Kellgren & Lawrence（K&L）、国际膝关节文献委员会（IKDC）、Ahlbäck 和 Fairbank。评估由两名观察者独立进行，在相隔 8 周的两个不同时间点进行。然后对数据进行统计学分析并计算观察者间和观察者内的可靠性。
所有四种分级系统在 AP 和 Rosenberg 位 X 线片之间均存在显著差异（p<0.001）。IKDC 的观察者间和观察者内可靠性最高（分别为 0.79 和 0.86），而 Fairbank 的最低（分别为 0.20 和 0.27）。任何分级系统与牛津膝关节评分（OKS）之间均未发现统计学显著相关性。
IKDC 被发现是最可靠的分级系统，而 Fairbank 则是最不可靠的。Rosenberg 位 X 线片总体上比 AP 位 X 线片更能敏感地检测出严重 OA。放射学发现与患者报告的症状（OKS）无关。
